Canadian scientists may be on the verge of a reliable test for concussions

Toronto Star

January 21, 2022

It’s been more than a decade since Dr. Charles Tator, the Toronto neurosurgeon, emerged as an authoritative voice of reason in the effort to curtail concussions in sports.

And while there’ve been low moments along the way, like the time Tator was swamped with hate mail after he dared call out Don Cherry as a negative influence in hockey’s deadly dance with brain injuries, Tator will tell you there’s been “terrific progress” in the field. Awareness has led to prevention. There are concussion laws on the books in Ontario, not to mention all 50 U.S. states.

“We have reached a stage where moms and dads, coaches and referees, are now thinking concussion,” Tator said in a recent interview. “We’ve come a long way.”

But there are things that haven’t changed much. Diagnosing concussions can still prove difficult. So can determining when a concussed athlete is fit to return to play. There’s no simple scan that tells the story, no definitive test on which a doctor can rely.

So Tator is among those excited by the prospect that there might be one soon enough, perhaps even a made-in-Canada solution. Clinical scientists in London, Ont., appear to be among the global leaders in the race to develop a reliable test for concussion by combining the burgeoning fields of biomarkers and artificial intelligence. The emerging technology in question, developed by Dr. Doug Fraser, one of the founders of London-based Neurolytixs, takes a few drops of blood from the prick of a finger and, once the sample has been applied to a filter-paper cartridge and transported to a lab, compares it against a baseline blood sample taken before the season. By analyzing important biomarkers in the blood — key molecules whose concentrations have been observed by Neurolytixs to reliably change after an individual suffers brain trauma — it can be determined whether or not someone has suffered a concussion in a matter of about 20 minutes.

Fraser said the Neurolytixs test, which has shown up to 96 per cent accuracy in preliminary research, is currently being tailored to adolescents aged 13 to 17.

“There’s a high number of concussions in that age group. And it’s a population that needs to be protected,” Fraser said. “They’ve got a lot of years to live, and concussions need to be recognized and they need to be treated appropriately.”

Already licenced and patented around the world, the Neurolytixs blood test is due to begin clinical trials with the U.S. Food and Drug Administration in the coming months. If all goes well, the test, which Fraser said will likely cost in the range of $100, could be available for use as early as 2023.

“What we’re really trying to do is make sure concussions aren’t missed,” Fraser said. “Because when you have cumulative concussions, that’s when the symptoms become more debilitating and are more likely to become lifelong. And in some rare cases, they can be life-ending.”

There are no sure things, of course. The pandemic has put a wrench in the gears of non-COVID-related medical innovation. Neurolytixs, which figures to spend in the range of $3 million to $5 million to develop its concussion test, is already six years into the process, which included a eureka moment parsing research data via artificial intelligence that first identified blood-based biomarkers that showed promise. Checking the many boxes of clinical trials is complicated business. And the Neurolytixs team isn’t the only group of scientists racing to bring to market a reliable concussion test. One rugby-centric research group has identified a saliva test for concussion with 96 per cent accuracy, according to a paper in the British Journal of Sports Medicine. There are at least a couple of other research teams, one based in Alberta, that claim to have successfully detected concussions through urinalysis. The list goes on.

“It’s like finding the brass ring — the whole world is looking for this,” Tator said. “I would probably put a biomarker test as number one for potential improvements (in the brain-injury space).”

Dr. Robert Cantu, the co-founder and medical director of the U.S.-based Concussion Legacy Foundation, said that while a biomarker test for concussion would be useful, it would be “even more useful” if it could tell doctors when a concussion’s effects had subsided. Cantu said there’s been research that indicates current return-to-play protocols “may be sending some people back too soon.”

“The major concerns continue to be when is it safe for somebody to go back and take more head trauma after they’ve had a concussion. And that is something we really do not have the answers to today,” Cantu said. “And that, I think, is really where (a biomarker test) is ultimately going to be used in clinics even more widely than to diagnose a concussion.”

Tator said he is hopeful a biomarker test might also shed light on the severity of any given concussion.

“We’re still not able to tell how bad a concussion it is. So far, all we can say is it’s a concussion. We can’t say it’s grade one, grade two, grade three,” Tator said. “It would be wonderful if we could grade the severity of a concussion. That would be very helpful to the field, so we’d know if a person has to sit out a week or a month to allow the brain to get better.”

Fraser said research at Neurolytixs is currently investigating whether its blood test will be useful in gauging severity or guiding return-to-play decisions. Even if it can’t, Fraser said there’s value in the peace of mind that would come with a definitive concussion diagnosis. And certainly there are practical uses for the test that go beyond the playing field. Insurance companies, for instance, have expressed interest in the Neurolytixs test for obvious reasons; concussion symptoms have been known to be feigned.

Said Cantu: “Not everyone’s an honest person in terms of their motivations when it comes to workman’s comp or insurance.”

In other words, there’s a real opportunity for more than one breakthrough here. The holy grail, in some eyes, would be a biomarker test for chronic traumatic encephalopathy (CTE), the degenerative brain condition linked to repetitive head trauma that has still only been identified in autopsies. But on the road from here to there, both Tator and Cantu are intrigued by the possibilities.

“(Biomarker technology) is emerging, it’s promising. It’s research data so far not confirmed by large clinical studies. Will it prove to be valuable? We certainly hope. I just don’t know at this point,” Cantu said.

Said Tator: “It would be lovely if it happened for a Canadian team. I’d love to see that.”

A sentiment with which Don Cherry would surely concur.

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